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Clinical Rehabilitation Feb 2002Dysarthria is a common sequel of nonprogressive brain damage (typically stroke and traumatic brain damage). Impairment-based therapy and a wide variety of compensatory... (Review)
Review
BACKGROUND
Dysarthria is a common sequel of nonprogressive brain damage (typically stroke and traumatic brain damage). Impairment-based therapy and a wide variety of compensatory management strategies are undertaken by speech and language therapists with this patient population.
OBJECTIVE
To determine the efficacy of speech and language therapy interventions for adults with dysarthria following nonprogressive brain damage.
DESIGN
Systematic review.
SEARCH STRATEGY
This review has drawn on the search strategies developed for the following Cochrane Groups as a whole: Stroke, Injuries, and Infectious Diseases. Relevant trials were identified in the Specialised Registers of Controlled Trials. We also searched the trials register of the Cochrane Rehabilitation and Related Therapies Field. The Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PsycLIT, and Linguistics and Language Behavior Abstracts were electronically searched. Hand-searching of the International Journal of Language and Communication Disorders and of reference lists from relevant articles and conference proceedings was also undertaken. Colleagues were approached to identify other possible published and unpublished studies.
SELECTION CRITERIA
Unconfounded randomized controlled trials.
DATA COLLECTION AND ANALYSIS
One reviewer assessed trial quality. Two co-reviewers were available to examine any potential trials for possible inclusion in the review.
MAIN RESULTS
No trials of the required standard were identified.
REVIEWERS' CONCLUSIONS
There is no evidence of the quality required by this review to support or refute the effectiveness of speech and language therapy interventions for dysarthria following nonprogressive brain damage. There is an urgent need for good quality research in this area.
Topics: Adult; Brain Damage, Chronic; Dysarthria; Humans; Language Therapy; Randomized Controlled Trials as Topic; Speech Therapy
PubMed: 11837527
DOI: 10.1191/0269215502cr468oa -
Neuro-degenerative Diseases 2019Dysarthria in neurological disorders can have psychosocial consequences. The dysarthric speaker's perspective towards the disorder's psychosocial impact is essential in... (Comparative Study)
Comparative Study
BACKGROUND
Dysarthria in neurological disorders can have psychosocial consequences. The dysarthric speaker's perspective towards the disorder's psychosocial impact is essential in its global assessment and management. For such purposes, assessment tools such as the Dysarthria Impact Profile (DIP) are indispensable.
OBJECTIVE
We aimed to confirm the relevance of using the DIP to quantify the psychosocial consequences of dysarthria in neurological diseases.
METHODS
We studied 120 participants, 15 healthy controls and 105 patients with different kinds of dysarthria induced by several neurological disorders (Parkinson's disease [PD], Huntington's disease, dystonia, cerebellar ataxia, progressive supranuclear palsy [PSP], multiple system atrophy, lateral amyotrophic sclerosis). All participants underwent a cognitive evaluation and a speech intelligibility assessment and completed three self-reported questionnaires: the 36-Item Short Form Health Survey, the Voice Handicap Index (VHI), and the DIP.
RESULTS
The psychometric properties of the DIP were confirmed, including internal consistency (α = 0.93), concurrent validity (correlation with the VHI: r = -0.77), and discriminant validity (accuracy = 0.93). Psychosocial impact of dysarthria was revealed by the DIP for all patients. Intelligibility loss was found strongly correlated with the psychosocial impact of dysarthria: for a similar level of intelligibility impairment, the DIP total score was similar regardless of the pathological group. However, our findings suggest that the psychosocial impact measured by the DIP could be partially independent from the severity of dysarthria (indirectly addressed here via speech intelligibility): the DIP was able to detect patients without any intelligibility impairment, but with a psychosocial impact.
CONCLUSIONS
All patients reported a communication complaint, attested by the DIP scores, despite the fact that not all patients, notably PD, ataxic, and PSP patients, had an intelligibility deficit. The DIP should be used in clinical practice to contribute to a holistic evaluation and management of functional communication in patients with dysarthria.
Topics: Adult; Aged; Aged, 80 and over; Communication Barriers; Dysarthria; Female; Humans; Male; Mental Status and Dementia Tests; Middle Aged; Neurodegenerative Diseases; Patient Reported Outcome Measures; Phenotype; Psychology; Psychometrics; Severity of Illness Index; Speech Intelligibility
PubMed: 31112944
DOI: 10.1159/000499627 -
International Journal of Language &... Jul 2017Although tongue twisters have been widely use to study speech production in healthy speakers, few studies have employed this methodology for individuals with speech...
Although tongue twisters have been widely use to study speech production in healthy speakers, few studies have employed this methodology for individuals with speech impairment. The present study compared tongue twister errors produced by adults with dysarthria and age-matched healthy controls. Eight speakers (four female, four male; mean age = 54.5 years) with spastic (mixed-spastic) dysarthria of varying aetiology (cerebral palsy, multiple sclerosis, multiple system atrophy) and eight controls (four female, four male; mean age = 56.9 years) were audio-recorded producing tongue twisters. One word in each tongue twister was marked for prominence. Speakers with dysarthria produced significantly more errors and spoke slower than healthy controls. The effect of prominence was significant for both groups-words spoken with prosodic prominence were significantly less error prone compared with words without prominence. While both groups produced most errors on words in the third position (of four-word utterances), speakers with dysarthria also produced high rates of errors on the first and fourth words. This preliminary investigation demonstrated the promise of applying the tongue twister paradigm to speakers with dysarthria and contributes to the evidence base for the implementation of prosodic strategies in speech intervention.
Topics: Adult; Aged; Case-Control Studies; Dysarthria; Female; Humans; Male; Middle Aged; Motor Activity; Motor Skills; Preliminary Data; Speech; Speech Acoustics; Speech Intelligibility; Speech Production Measurement; Tongue
PubMed: 27891744
DOI: 10.1111/1460-6984.12285 -
The Cochrane Database of Systematic... 2001Dysarthria is a common manifestation of Parkinson's disease which increases in frequency and intensity with the progress of the disease (Streifler 1984). Up to 20% of... (Review)
Review
BACKGROUND
Dysarthria is a common manifestation of Parkinson's disease which increases in frequency and intensity with the progress of the disease (Streifler 1984). Up to 20% of Parkinsonian patients are referred for speech and language therapy (S & L T), its aim being to improve the intelligibility of the patient's speech.
OBJECTIVES
To compare the efficacy of speech and language therapy versus placebo or no interventions in patients with Parkinson's disease.
SEARCH STRATEGY
Relevant trials were identified by electronic searches of MEDLINE, EMBASE, CINAHL, ISI-SCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICST-EPlus, AIM, IMEMR, SIGLE, ISI-ISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR; and examination of the reference lists of identified studies and other reviews.
SELECTION CRITERIA
Only randomised controlled trials (RCT) were included.
DATA COLLECTION AND ANALYSIS
Data were abstracted independently by KD and RW and differences settled by discussion.
MAIN RESULTS
Three randomised controlled trials were found comparing speech and language therapy with placebo for speech disorders in Parkinson's disease. A total of 63 patients were examined. The loudness of the patients' voices were increased by between 7-18%, depending on the speaking task being performed. It is likely that this is a clinically significant improvement. After six months the degree of improvement was reduced but was still statistically significant. Overall measures of dysarthria were measured in two trials and also improved. The clinical significance of these improvements was less clear cut as intelligibility of speech was not measured in any of these studies.
REVIEWER'S CONCLUSIONS
Considering the small number of patients examined, the methodological flaws in many of the studies, and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of speech and language therapy for dysarthria in Parkinson's disease. A Delphi-style survey is needed to develop a consensus as to what is 'standard' S< for dysarthria in Parkinson's disease. Then a large well designed placebo-controlled RCT is needed to demonstrate speech and language therapy's effectiveness for dysarthria in Parkinson's disease. The trial should conform to CONSORT guidelines. Outcome measures with particular relevance to patients should be chosen and the patients followed for at least 6 months to determine the duration of any improvement.
Topics: Dysarthria; Humans; Language Therapy; Parkinson Disease; Randomized Controlled Trials as Topic; Speech Therapy
PubMed: 11406044
DOI: 10.1002/14651858.CD002812 -
Cognitive Determinants of Dysarthria in Parkinson's Disease: An Automated Machine Learning Approach.Movement Disorders : Official Journal... Dec 2021Dysarthric symptoms in Parkinson's disease (PD) vary greatly across cohorts. Abundant research suggests that such heterogeneity could reflect subject-level and...
BACKGROUND
Dysarthric symptoms in Parkinson's disease (PD) vary greatly across cohorts. Abundant research suggests that such heterogeneity could reflect subject-level and task-related cognitive factors. However, the interplay of these variables during motor speech remains underexplored, let alone by administering validated materials to carefully matched samples with varying cognitive profiles and combining automated tools with machine learning methods.
OBJECTIVE
We aimed to identify which speech dimensions best identify patients with PD in cognitively heterogeneous, cognitively preserved, and cognitively impaired groups through tasks with low (reading) and high (retelling) processing demands.
METHODS
We used support vector machines to analyze prosodic, articulatory, and phonemic identifiability features. Patient groups were compared with healthy control subjects and against each other in both tasks, using each measure separately and in combination.
RESULTS
Relative to control subjects, patients in cognitively heterogeneous and cognitively preserved groups were best discriminated by combined dysarthric signs during reading (accuracy = 84% and 80.2%). Conversely, patients with cognitive impairment were maximally discriminated from control subjects when considering phonemic identifiability during retelling (accuracy = 86.9%). This same pattern maximally distinguished between cognitively spared and impaired patients (accuracy = 72.1%). Also, cognitive (executive) symptom severity was predicted by prosody in cognitively preserved patients and by phonemic identifiability in cognitively heterogeneous and impaired groups. No measure predicted overall motor dysfunction in any group.
CONCLUSIONS
Predominant dysarthric symptoms appear to be best captured through undemanding tasks in cognitively heterogeneous and preserved cohorts and through cognitively loaded tasks in patients with cognitive impairment. Further applications of this framework could enhance dysarthria assessments in PD. © 2021 International Parkinson and Movement Disorder Society.
Topics: Cognition; Cognitive Dysfunction; Dysarthria; Humans; Machine Learning; Parkinson Disease; Speech
PubMed: 34390508
DOI: 10.1002/mds.28751 -
Journal of Speech, Language, and... Mar 2022Oral diadochokinesis (DDK) is a standard dysarthria assessment task. To extract automatic and semi-automatic DDK measurements, numerous DDK analysis algorithms based on...
PURPOSE
Oral diadochokinesis (DDK) is a standard dysarthria assessment task. To extract automatic and semi-automatic DDK measurements, numerous DDK analysis algorithms based on acoustic signal processing are available, including amplitude based, spectral based, and hybrid. However, these algorithms have been predominantly validated in individuals with no perceptible to mild dysarthria. The behavior of these algorithms across dysarthria severity is largely unknown. Likewise, these algorithms have not been tested equally for various syllable types. The goal of this study was to evaluate the performance of five common DDK algorithms as a function of dysarthria severity, considering syllable types.
METHOD
We analyzed 282 DDK recordings of /ba/, /pa/, and /ta/ from 145 participants with amyotrophic lateral sclerosis. Recordings were stratified into mild, moderate, or severe dysarthria groups based on individual performance on the Speech Intelligibility Test. Analysis included manual and automatic estimation of the number of syllables, DDK rate, and cycle-to-cycle temporal variability (cTV). Validation metrics included Bland-Altman mixed-effects limits of agreement between manual and automatic syllable counts, recall and precision between manual and automatic syllable boundary detection, and Kendall's tau-b correlations between manual and algorithm-detected DDK rate and cTV.
RESULTS
The amplitude-based algorithm (absolute energy) yielded the strongest correlations with manual analysis across all severity groups for DDK rate ( = 0.7-0.84) and cTV ( = 0.7-0.84) and the narrowest limits of agreement (-5.92 to 7.12 syllable difference). Moreover, this algorithm also provided the highest mean recall and precision across severity groups for /ba/ and /pa/, but with significantly more variation for/ta/.
CONCLUSIONS
Algorithms based on signal energy analysis appeared to be the most robust for DDK analysis across dysarthria severity and syllable types; however, it remains prone to error against severe dysarthria and alveolar syllable context. Further development is needed to address this important issue.
Topics: Acoustics; Algorithms; Amyotrophic Lateral Sclerosis; Dysarthria; Humans; Speech Production Measurement
PubMed: 35171700
DOI: 10.1044/2021_JSLHR-21-00503 -
Journal of Speech, Language, and... Jan 2022Despite extensive research into communication-related parameters in dysarthria, such as intelligibility, naturalness, and perceived listener effort, the existing...
PURPOSE
Despite extensive research into communication-related parameters in dysarthria, such as intelligibility, naturalness, and perceived listener effort, the existing evidence has not been translated into a clinically applicable, comprehensive, and valid diagnostic tool so far. This study addresses Communication-Related Parameters in Speech Disorders (KommPaS), a new web-based diagnostic instrument for measuring indices of communication limitation in individuals with dysarthria through online crowdsourcing. More specifically, it answers questions about the construct validity of KommPaS. In the first part, the interrelationship of the KommPaS variables were explored in order to draw a comprehensive picture of a patient's limitations and avoid the collection of redundant information. Second, the influences of motor speech symptoms on the KommPaS variables were studied in order to delineate the structural relationships between two complementary diagnostic perspectives.
METHOD
One hundred persons with dysarthria of different etiologies and varying degrees of severity were examined with KommPaS to obtain layperson-based data on communication-level parameters, and with the Bogenhausen Dysarthria Scale (BoDyS) to obtain expert-based, function-level data on dysarthria symptoms. The internal structure of the KommPaS variables and their dependence on the BoDyS variables were analyzed using structural equation modeling.
RESULTS
Despite a high multicollinearity, all KommPaS variables were shown to provide complementary diagnostic information and their mutual interconnections were delineated in a path graph model. Regarding the influence of the BoDyS scales on the KommPaS variables, separate linear regression models revealed plausible predictor sets. A complete path model of KommPaS and BoDyS variables was developed to map the complex interplay between variables at the functional and the communication levels of dysarthria assessment.
CONCLUSION
In validating a new clinical tool for the diagnostics of communication limitations in dysarthria, this study is the first to draw a comprehensive picture of how auditory-perceptual characteristics of dysarthria interact at the levels of expert-based functional and layperson-based communicative assessments.
Topics: Cognition; Dysarthria; Humans; Mobile Applications; Speech Intelligibility; Speech Production Measurement
PubMed: 34890213
DOI: 10.1044/2021_JSLHR-21-00215 -
International Journal of Language &... Mar 2021The articulatory accuracy of patients with dysarthria is one of the most affected speech dimensions with a high impact on speech intelligibility. Behavioural treatments... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The articulatory accuracy of patients with dysarthria is one of the most affected speech dimensions with a high impact on speech intelligibility. Behavioural treatments of articulation can either involve direct or indirect approaches. The latter have been thoroughly investigated and are generally appreciated for their almost immediate effects on articulation and intelligibility. The number of studies on (short-term) direct articulation therapy is limited.
AIMS
To investigate the effects of short-term, boost articulation therapy (BArT) on speech intelligibility in patients with chronic or progressive dysarthria and the effect of severity of dysarthria on the outcome.
METHODS & PROCEDURES
The study consists of a two-group pre-/post-test design to assess speech intelligibility at phoneme and sentence level and during spontaneous speech, automatic speech and reading a phonetically balanced text. A total of 17 subjects with mild to severe dysarthria participated in the study and were randomly assigned to either a patient-tailored, intensive articulatory drill programme or an intensive minimal pair training. Both training programmes were based on the principles of motor learning. Each training programme consisted of five sessions of 45 min completed within one week.
OUTCOMES & RESULTS
Following treatment, a statistically significant increase of mean group intelligibility was shown at phoneme and sentence level, and in automatic sequences. This was supported by an acoustic analysis that revealed a reduction in formant centralization ratio. Within specific groups of severity, large and moderate positive effect sizes with Cohen's d were demonstrated.
CONCLUSIONS & IMPLICATIONS
BArT successfully improves speech intelligibility in patients with chronic or progressive dysarthria at different levels of the impairment. What this paper adds What is already known on the subject Behavioural treatment of articulation in patients with dysarthria mainly involves indirect strategies, which have shown positive effects on speech intelligibility. However, there is limited evidence on the short-term effects of direct articulation therapy at the segmental level of speech. This study investigates the effectiveness of BArT on speech intelligibility in patients with chronic or progressive dysarthria at all severity levels. What this paper adds to existing knowledge The intensive and direct articulatory therapy programmes developed and applied in this study intend to reduce the impairment instead of compensating it. This approach results in a significant improvement of speech intelligibility at different dysarthria severity levels in a short period of time while contributing to exploit and develop all available residual motor skills in persons with dysarthria. What are the potential or actual clinical implications of this work? The improvements in intelligibility demonstrate the effectiveness of a BArT at the segmental level of speech. This makes it to be considered a suitable approach in the treatment of patients with chronic or progressive dysarthria.
Topics: Adult; Behavior Therapy; Dysarthria; Humans; Speech Articulation Tests; Speech Intelligibility; Speech Production Measurement
PubMed: 33484095
DOI: 10.1111/1460-6984.12595 -
Journal of Speech, Language, and... Feb 2014The purpose of this study was to determine the extent to which vowel metrics are capable of distinguishing healthy from dysarthric speech and among different forms of...
PURPOSE
The purpose of this study was to determine the extent to which vowel metrics are capable of distinguishing healthy from dysarthric speech and among different forms of dysarthria.
METHOD
A variety of vowel metrics were derived from spectral and temporal measurements of vowel tokens embedded in phrases produced by 45 speakers with dysarthria and 12 speakers with no history of neurological disease. Via means testing and discriminant function analysis (DFA), the acoustic metrics were used to (a) detect the presence of dysarthria and (b) classify the dysarthria subtype.
RESULTS
Significant differences between dysarthric and healthy control speakers were revealed for all vowel metrics. However, the results of the DFA demonstrated some metrics (particularly metrics that capture vowel distinctiveness) to be more sensitive and specific predictors of dysarthria. Only the vowel metrics that captured slope of the second formant (F2) demonstrated between-group differences across the dysarthrias. However, when subjected to DFA, these metrics proved unreliable classifiers of dysarthria subtype.
CONCLUSION
The results of these analyses suggest that some vowel metrics may be useful clinically for the detection of dysarthria but may not be reliable indicators of dysarthria subtype using the current dysarthria classification scheme.
Topics: Adult; Aged; Aged, 80 and over; Amyotrophic Lateral Sclerosis; Databases, Factual; Dysarthria; Female; Humans; Huntington Disease; Male; Middle Aged; Parkinson Disease; Phonetics; Speech Acoustics; Speech Production Measurement
PubMed: 24687467
DOI: 10.1044/1092-4388(2013/12-0262) -
Acute Medicine 2021Internal carotid artery dissection commonly affects younger patients. We present a case of a previously fit and well 43-year-old gentleman who presented with a sudden...
Internal carotid artery dissection commonly affects younger patients. We present a case of a previously fit and well 43-year-old gentleman who presented with a sudden onset of slurring of speech, with right-sided tongue deviation and fasciculation on examination. Signs and symptoms began following participation in a home workout class. Magnetic resonance angiography revealed right-sided extracrainal internal carotid artery dissection leading to right-sided unilateral twelfth cranial nerve palsy.
Topics: Adult; Carotid Artery, Internal, Dissection; Dysarthria; Humans; Magnetic Resonance Angiography; Male; Stroke
PubMed: 34190741
DOI: No ID Found